Author: Timothy O'Sullivan, MD
Senior Editor: Natalie Stork, MD
Editor: Anthony Shadiack, DO
A 13-year-old male ice hockey player, without significant past medical history, presented to the sports medicine clinic with 3 days of right sided sternal pain.
The patient was at an away hockey tournament 3 days prior where he collided into a larger opponent with direct contact to the right shoulder. He had immediate onset of pain at the right shoulder and chest. He went to a local Emergency Department the day of the injury where radiographs were negative for a clavicular or sternal fracture. He was placed in a sling and discharged home. He presented to the sports medicine clinic due to continued pain since the incident. The pain was described as sharp and worse with any shoulder movement. It improved some with use of the sling and rest. He reported that initially he had right sided neck pain and some difficulty swallowing, however this resolved. He denied any difficulty breathing, paresthesias, or weakness. He had no prior history of injuries to the shoulder.
The patient was uncomfortable due to pain. His skin was intact without bruising or bony prominence. There was mild swelling by the right sternoclavicular joint. He was tender to palpation at the midpoint of the right clavicle, the right sternoclavicular joint, and the sternum. There was no crepitus. The patient's shoulder motion was limited to 90 degrees of abduction and flexion due to pain. Strength testing of the shoulder with his arm adducted by his side and elbow flexed to 90 degrees was 5/5. His distal radial pulses were intact. He had full painless cervical range of motion and no tenderness to palpation of the spinous processes of the cervical spine. Light touch was intact in his bilateral upper extremities. Spurling's was negative. Deep tendon reflexes were normal.
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